Osteoporosis: Diet, Vitamins and the Dairy Myth

Donna W. Hill Dietician Mark Rifkin explains the diet's role in bone health, why increasing dairy hasn't worked and why pills can't supply the vitamins people need. As reports surface linking osteoporosis drugs to side effects like hip fracture and dead jaw syndrome, many people want safer ways to strengthen their bones. Washington, D.C. area dietician and licensed nutrition counselor Mark Rifkin spoke to Suite 101 about food, vitamins and bone health. Know Your Food Rifkin is a vegan, avoiding eggs and dairy. He is a realist, however, and respects other lifestyles. He also knows that being a vegetarian doesn't ensure smart food choices. Knowing what's in your food and understanding the diet's role in good health are the keys. "It surprises me," says Rifkin, who conducts counseling /educational programs through Preventive Nutrition Services, "That so many people still don't read labels." Read ingredients and nutritional information. Notice the serving size when calculating calories, fat and salt. They are often much smaller than what people actually eat. Calcium and Estrogen Conventional wisdom about osteoporosis says that the culprit is estrogen loss at menopause; the answer, more dairy. Rifkin explains that estrogen is not the only protective factor in bone health, and is "not a loss we can't compensate for." Increasing milk consumption hasn't worked. The government has retreated from its stance, though in a subtle way that has gone unnoticed. In 2005, due to conflicting data, the certainty of the recommendation was reduced. They now say "Adequate Intake" (AI) rather than "Recommended Daily Allowance" (RDA). The Food and Nutrition Board (FNB) lists 1200 mg daily as the AI of calcium for anyone over 50. "Nature only creates sustainable systems," states Rifkin, who isn't surprised by the change, "Why would nature assume that anyone would get 4 cups of milk a day when most people are lactose intolerant." Going Green for Bone Health The modern diet is low in fruits and vegetables and almost devoid of the most beneficial ones. Potatoes, which have little value, account for 30% of America's vegetable intake. Another favorite is iceberg lettuce. "It isn't worth the plastic it comes in," says Rifkin, "There's not one single nutrient in it, but it's the dominant lettuce in America." Fruits and veggies, especially the dark green leafy ones, are rich sources of calcium. They also have other benefits. There are at least 12 factors in bone building, including B 12, omega fatty acids, magnesium, iron and boron. A plant based diet, rich in beans and greens, is the best source of these essentials. Collard greens, kale and bok choy are the top calcium sources. The National cancer institute finds that from 2001-04 the average dark-green-vegetable intake was one tenth of a serving daily, just 2 tablespoons. The most important deficiency this represents is vitamin K. "Vitamin K from dark green veggies," Rifkin explains, "builds the enzymes that help the body deposit calcium in the right way." Vitamins and Bone Health Americans know that vitamins are important. Pills, however, can't supply these essential nutrients. Of the 10,000 chemicals in plants, only a few are put into pills. "Americans are deficient in vitamin E, for instance," Rifkin explains, "but so far, only one component of it -- alpha-tocoferol -- can be made into pills. We should get it from food where it exists in all of its forms." Rifkin says most multivitamins are mineral deficient. Many contain poorly researched substances. People consume unneeded and dangerous vitamins. Most people don't need vitamin C, which is readily available in the diet. Vitamin A, which at proper levels has a protective impact on bone health, can easily be overdone. Too much can lead to bone loss. Sweet potatoes and cantaloupes supply needed vitamin A without overdosing. Folic acid presents too much of a risk to supplement. A diet rich in green leafy vegetables provides enough folic acid without the risk. "There are studies showing these vitamins are harmful," Rifkin states, "There's no reason you can't go eat a vegetable." People living north of Atlanta, Dallas or Los Angeles need vitamin d. It is crucial for healthy bones. The International Osteoporosis Foundation recently increased its vitamin D recommendations. Older adults need 800 to 1,000 IUs daily. Those with osteoporosis, who are obese, who have limited sun exposure or have malabsorption should get 2,000 IUs daily. Fast Food, Salt and Bone Health The worst thing Americans do for their bones is salt. Sodium causes calcium to be excreted. In moderation, this wouldn't matter. Unfortunately, Americans gravitate to processed food. The more processed the food is; the more salt it likely contains. "People often get more salt in one fast food meal than they should have all day," Rifkin states. For salt levels in McDonald's, Berger King and Wendy's see "Sodium Content of Favorite Fast Foods." The University of Maine bulletin "Sodium Content of Your Food" gives more details. Healthy-Bone Habits Rifkin recommends significantly improving the variety and quantity of fruits and veggies. Cut back on salty foods and meat. Remember that weight-bearing exercise is the most important factor in bone health, and consult your doctor before discontinuing any medication.

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